The i-gel® supraglottic airway device compared to endotracheal intubation as the initial prehospital advanced airway device : A natural experiment during the COVID-19 pandemic
© 2024 The Authors. Journal of the American College of Emergency Physicians Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians..
Objective: Unlike randomized controlled trials, practical real-world studies can offer important information about implementation of prehospital interventions, particularly in community settings where there may be reluctance to adopt new practices. We present the results of a natural experiment that was driven by mandated COVID-19 pandemic-driven shift from endotracheal intubation (ETI) to the i-gel® supraglottic airway (SGA) as a primary advanced airway management device in the prehospital setting to reduce emergency medical services (EMS) personnel exposure to potentially infectious secretions. The objective was to compare first-pass success and timing to successful airway placement between ETI and the i-gel® SGA under extenuating circumstances.
Methods: This pre/post study compared airway placement metrics in prehospital patients requiring advance airway management for non-trauma-related conditions. Data from EMS records were extracted over 2 years, 12 months pre-pandemic, and 12 months post-pandemic. During the pre-COVID-19 year, the EMS protocols utilized ETI as the primary advanced airway device (ETI group). Post-pandemic paramedics were mandated to utilize i-gel® SGA as the primary advanced airway device to reduce exposure to secretions (SGA group).
Results: There were 199 adult patients, 83 (42%) in the ETI group and 116 (58%) in the SGA group. First-pass success was significantly higher with SGA 96% (92%-99%) than ETI 68% (57%-78%) with paramedics citing the inability to visualize the airway in 52% of ETI cases. Time to first-pass success was significantly shorter in the SGA group (5.9 min [5.1-6.7 min]) than in the ETI group (8.3 min [6.9-9.6 min]), as was time to overall successful placement at 6.0 min (5.1-6.8 min) versus 9.6 min (8.2-11.1 min), respectively. Multiple placement attempts were required in 26% of ETI cases and 1% of the SGA cases. There were no statistically significant differences in the number and types of complications between the cohorts. Return of spontaneous circulation (on/before emergency department [ED] arrival), mortality at 28 days, intensive care unit length of stay, or ventilator-free days between the groups were not statistically different between the groups.
Conclusion: In this natural experiment, the SGA performed significantly better than ETI in first-pass airway device placement success and was significantly faster in achieving first-pass success, and overall airway placement, thus potentially reducing exposure to respiratory pathogens. Practical real-world studies can offer important information about implementation of prehospital interventions, particularly in community settings and in systems with a low frequency of tracheal intubations.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:5 |
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| Enthalten in: |
Journal of the American College of Emergency Physicians open - 5(2024), 2 vom: 24. Apr., Seite e13150 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Levi, Daniel [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Revised 06.04.2024 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1002/emp2.13150 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM370660234 |
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| 100 | 1 | |a Levi, Daniel |e verfasserin |4 aut | |
| 245 | 1 | 4 | |a The i-gel® supraglottic airway device compared to endotracheal intubation as the initial prehospital advanced airway device |b A natural experiment during the COVID-19 pandemic |
| 264 | 1 | |c 2024 | |
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| 500 | |a Date Revised 06.04.2024 | ||
| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2024 The Authors. Journal of the American College of Emergency Physicians Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians. | ||
| 520 | |a Objective: Unlike randomized controlled trials, practical real-world studies can offer important information about implementation of prehospital interventions, particularly in community settings where there may be reluctance to adopt new practices. We present the results of a natural experiment that was driven by mandated COVID-19 pandemic-driven shift from endotracheal intubation (ETI) to the i-gel® supraglottic airway (SGA) as a primary advanced airway management device in the prehospital setting to reduce emergency medical services (EMS) personnel exposure to potentially infectious secretions. The objective was to compare first-pass success and timing to successful airway placement between ETI and the i-gel® SGA under extenuating circumstances | ||
| 520 | |a Methods: This pre/post study compared airway placement metrics in prehospital patients requiring advance airway management for non-trauma-related conditions. Data from EMS records were extracted over 2 years, 12 months pre-pandemic, and 12 months post-pandemic. During the pre-COVID-19 year, the EMS protocols utilized ETI as the primary advanced airway device (ETI group). Post-pandemic paramedics were mandated to utilize i-gel® SGA as the primary advanced airway device to reduce exposure to secretions (SGA group) | ||
| 520 | |a Results: There were 199 adult patients, 83 (42%) in the ETI group and 116 (58%) in the SGA group. First-pass success was significantly higher with SGA 96% (92%-99%) than ETI 68% (57%-78%) with paramedics citing the inability to visualize the airway in 52% of ETI cases. Time to first-pass success was significantly shorter in the SGA group (5.9 min [5.1-6.7 min]) than in the ETI group (8.3 min [6.9-9.6 min]), as was time to overall successful placement at 6.0 min (5.1-6.8 min) versus 9.6 min (8.2-11.1 min), respectively. Multiple placement attempts were required in 26% of ETI cases and 1% of the SGA cases. There were no statistically significant differences in the number and types of complications between the cohorts. Return of spontaneous circulation (on/before emergency department [ED] arrival), mortality at 28 days, intensive care unit length of stay, or ventilator-free days between the groups were not statistically different between the groups | ||
| 520 | |a Conclusion: In this natural experiment, the SGA performed significantly better than ETI in first-pass airway device placement success and was significantly faster in achieving first-pass success, and overall airway placement, thus potentially reducing exposure to respiratory pathogens. Practical real-world studies can offer important information about implementation of prehospital interventions, particularly in community settings and in systems with a low frequency of tracheal intubations | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a COVID‐19 | |
| 650 | 4 | |a ICU length of stay | |
| 650 | 4 | |a airway | |
| 650 | 4 | |a emergency medical services | |
| 650 | 4 | |a endotracheal intubation | |
| 650 | 4 | |a mortality | |
| 650 | 4 | |a out‐of‐hospital cardiac arrest | |
| 650 | 4 | |a pandemic | |
| 650 | 4 | |a paramedics | |
| 650 | 4 | |a prehospital | |
| 650 | 4 | |a return of spontaneous circulation | |
| 650 | 4 | |a supraglottic airway | |
| 650 | 4 | |a ventilator‐free days | |
| 700 | 1 | |a Hoogendoorn, Joris |e verfasserin |4 aut | |
| 700 | 1 | |a Samuels, Shenae |e verfasserin |4 aut | |
| 700 | 1 | |a Maguire, Lindsay |e verfasserin |4 aut | |
| 700 | 1 | |a Troncoso, Ruben |e verfasserin |4 aut | |
| 700 | 1 | |a Gunn, Scott |e verfasserin |4 aut | |
| 700 | 1 | |a Katz, Matthew |e verfasserin |4 aut | |
| 700 | 1 | |a VanDillen, Christine |e verfasserin |4 aut | |
| 700 | 1 | |a Miller, Susan A |e verfasserin |4 aut | |
| 700 | 1 | |a Falk, Jay L |e verfasserin |4 aut | |
| 700 | 1 | |a Katz, Steven H |e verfasserin |4 aut | |
| 700 | 1 | |a Papa, Linda |e verfasserin |4 aut | |
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